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Surveillance for Foodborne Disease Outbreaks United States, 2016: Annual Report
AcknowledgementsWe would like to thank local, state, and territorial health department
officials and CDC staff for conducting the investigations and submitting the outbreak reports that made this summary possible.
Suggested CitationCenters for Disease Control and Prevention (CDC). Surveillance for
Foodborne Disease Outbreaks, United States, 2016, Annual Report. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, 2018.
Report compiled byDaniel Dewey-Mattia, Hannah Kisselburgh, Karunya Manikonda, Rachel Silver,
Sanjana Subramhanya, Preethi Sundararaman, Hilary Whitham, and Samuel Crowe
Centers for Disease Control and PreventionNational Center for Emerging and Zoonotic Infectious Diseases
Division of Foodborne, Waterborne, and Environmental DiseasesEnteric Diseases Epidemiology Branch
1600 Clifton Road, Mail Stop C-09, Atlanta, GA 30329-4027Telephone: 404.639.2206
E-mail: [email protected]: http://www.cdc.gov/foodsafety/fdoss/
Surveillance for Foodborne Disease Outbreaks
United States
2016 Annual Report
ContentsHighlights............................................................................................................................................................................................1
Background ........................................................................................................................................................................................1
Methods ..............................................................................................................................................................................................1
Findings ...............................................................................................................................................................................................2
Limitations ..........................................................................................................................................................................................3
References...........................................................................................................................................................................................3
Figure: Rate of reported foodborne disease outbreaks per one million population and number of outbreaks, by state and confirmed and suspected etiology ...........................................................4
Table 1: Foodborne disease outbreaks, outbreak-associated illnesses, and hospitalizations, by etiology ..........................................................................................................................................................................................6
Table 2a: Foodborne disease outbreaks and outbreak-associated illnesses, by food category ......................7
Table 2b: Most common pathogen-food category pairs resulting in outbreaks, outbreak-associated illnesses, hospitalizations, and deaths ...........................................................................................8
Table 3a: Foodborne disease outbreaks and outbreak-associated illnesses, by location of food preparation ..............................................................................................................................................................................9
Table 3b: Foodborne disease outbreaks and outbreak-associated illnesses, by confirmed etiology and location of food preparation .............................................................................................................................................. 10
Table 3c: Foodborne disease outbreaks and outbreak-associated illnesses, by suspected etiology and location of food preparation .............................................................................................................................................. 11
Table 4: Multistate foodborne disease outbreaks ........................................................................................................... 12
Appendix: Foodborne disease outbreaks by etiology and contributing factors ............................................... 13
1 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Highlights z In 2016, 839 foodborne disease outbreaks
were reported, resulting in 14,259 illnesses, 875 hospitalizations, 17 deaths, and 18 food product recalls.
z Norovirus was the most common cause of confirmed, single-etiology outbreaks, accounting for 145 (36%) outbreaks and 3,794 (42%) illnesses. Salmonella was the next most common cause, accounting for 132 (33%) outbreaks and 3,047 (33%) illnesses, followed by Shiga toxin-producing Escherichia coli, which caused 25 (6%) confirmed, single-etiology outbreaks and 366 (4%) illnesses.
z Fish (26 outbreaks), mollusks (21), and dairy (19) were the most common single food categories implicated. The most outbreak-associated illnesses were from mollusks (529 illnesses), pork (438), and grains and beans (383).
z As reported in previous years, restaurants (459 outbreaks, 61% of outbreaks reporting a single location of preparation), specifically restaurants with sit-down dining (363, 48%), were the most commonly reported locations of food preparation associated with outbreaks.
BackgroundFoodborne diseases due to known pathogens are estimated to cause 9.4 million illnesses each year in the United States.1 Although relatively few of these illnesses occur in the setting of a recognized outbreak, data collected during outbreak investigations provide insight into the pathogens and foods that cause illness. Public health officials, regulatory agencies, and the food industry can use these data to inform efforts to prevent foodborne disease.
MethodsAn outbreak of foodborne disease is defined as the occurrence of two or more cases of a similar illness resulting from ingestion of a common food. CDC conducts surveillance for foodborne disease outbreaks in the United States through the Foodborne Disease Outbreak Surveillance System. Public health agencies in all 50 states, Washington, D.C., and U.S. territories
submit reports of outbreaks investigated by their agencies using a web-based reporting platform, the National Outbreak Reporting System (NORS) (http://www.cdc.gov/nors/). This annual summary includes foodborne disease outbreaks reported by February 7, 2018, in which the first illness onset occurred in 2016. Agencies use a standard form (https://www.cdc.gov/nors/downloads/form-52-13.pdf ) to report foodborne disease outbreaks. Data requested for each outbreak include the reporting state; date of first illness onset; number of illnesses, hospitalizations, and deaths; etiology; implicated food(s) and ingredient(s); locations of food preparation; and factors contributing to food contamination (see appendix). The form also allows for reporting the reason(s) a particular food is suspected as the source; five choices are provided (http://www.cdc.gov/nors/downloads/guidance.pdf ). All foods implicated were included in analyses, regardless of the reasons suspected. Implicated foods were classified into 1 of 24 single-food categories if a single contaminated ingredient was identified or if all ingredients belonged to that category.2,3 Outbreaks attributed to foods that could not be assigned to one of these categories, or for which the report contained insufficient information for category assignment, were not attributed to a category.Reported etiologies were grouped as bacterial, chemical or toxin, parasitic, or viral. Etiologic agents were classified as confirmed if predefined criteria were met;4 otherwise, they were labeled suspected. In some outbreaks, the etiologic agent was not identified. If more than one agent was reported in an outbreak, it was categorized as a confirmed or suspected multiple etiology outbreak.Multistate outbreaks are defined as outbreaks in which exposure to the implicated food occurred in more than one state or territory. Implicated foods in multistate outbreaks were classified as confirmed or suspected based on epidemiologic, traceback, and laboratory evidence. A food was considered the confirmed source of a multistate outbreak if two types of evidence were obtained, while a food was considered suspected if only one type of evidence was available.
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Population-based outbreak reporting rates were calculated for each state using U.S. Census Bureau estimates of the 2016 state populations (http://www.census.gov/popest). Multistate outbreaks were included in state population-based outbreak reporting rates by assigning one outbreak to each state that reported a case in the outbreak.
FindingsDuring 2016, 839 foodborne disease outbreaks were reported (Table 1), resulting in 14,259 illnesses, 875 hospitalizations, and 17 deaths. Outbreaks were reported by public health officials from 50 states, Puerto Rico, and Washington, D.C., (Figure). The median reporting rate per million population was 3.6 outbreaks; rates ranged from 0.8 in Texas to 11.2 in Hawaii.
Etiologic AgentsA single etiologic agent was confirmed in 399 (48%) outbreaks (Table 1), which resulted in 9,123 (64%) illnesses. Bacteria caused the most outbreaks (219 outbreaks, 55%), followed by viruses (149, 37%), chemicals (26, 7%), and parasites (5, 1%). Norovirus was the most common cause of confirmed, single-etiology outbreaks, accounting for 145 (36%) outbreaks and 3,794 (42%) illnesses. Salmonella was the next most common cause, accounting for 132 (33%) outbreaks and 3,047 (33%) illnesses. Among the 125 confirmed Salmonella outbreaks with a serotype reported, Enteritidis was the most common (21 outbreaks, 17%), followed by I 4,[5],12:i:- (13, 10%), Newport (13, 10%), and Typhimurium (13, 10%). Shiga toxin-producing Escherichia coli (STEC) caused 25 confirmed, single-etiology outbreaks, of which 19 (76%) were caused by serogroup O157.Of the 9,123 outbreak-associated illnesses caused by a single confirmed etiologic agent, 812 (9%) resulted in hospitalization (Table 1). Among confirmed, single-etiology outbreaks, Salmonella caused the most outbreak-associated hospitalizations (456 hospitalizations, 56%), followed by hepatitis A virus (HAV) (141, 17%) and STEC (98, 12%). Outbreaks caused by Clostridium botulinum resulted in the highest proportion of ill persons hospitalized (100%), followed by Listeria monocytogenes (93%) and HAV (31%). Among the 17 deaths reported, 14 (82%) were
attributed to bacterial etiologies (Listeria monocytogenes [3], Salmonella [3], STEC [3], Clostridium botulinum [2], Clostridium perfringens [1], Staphylococcus aureus [1], and Vibrio cholera [1]). Two deaths were attributed to HAV and one death had an unknown etiology.
Food Categories ImplicatedA food source was reported for 323 (38%) outbreaks. In 180 (56%) of these outbreaks, the food could be classified into a single category (Table 2a). The categories most commonly implicated were fish (26 outbreaks, 14%), mollusks (21, 12%), dairy (19, 11%), and pork (18, 10%). All dairy outbreaks were due to unpasteurized products. The most outbreak-associated illnesses were from mollusks (529 illnesses), pork (438), grains and beans (383), and chicken (356).
Etiologic Agents and Food Category Pairs The pathogen-food category pairs responsible for most outbreaks were scombroid toxin (histamine) in fish (12 outbreaks), ciguatoxin in fish (11), and Salmonella in chicken (8) (Table 2b). The pathogen-food category pairs responsible for the most illnesses in outbreaks were Bacillus cereus in grains and beans (348 illnesses), Salmonella in chicken (307), and HAV in mollusks (281). The pathogen-food category pairs responsible for the most hospitalizations in outbreaks were HAV in mollusks (71 hospitalizations), HAV in fruits (57), and Salmonella in beef (44). Deaths were reported for the following pathogen-food category pairs: HAV in mollusks (2 deaths), Listeria monocytogenes in dairy (2), Salmonella in chicken (1), Vibrio cholerae in mollusks (1), and Salmonella in beef (1).
Location of Food PreparationAmong the 751 outbreaks and 12,622 illnesses with a reported single location where food was prepared, 459 outbreaks (61%) and 5,353 associated illnesses (42%) were attributed to foods prepared in a restaurant (Table 3a, Table 3b, and Table 3c). Among these outbreaks, sit-down dining restaurants were the type of facility most commonly reported (363 outbreaks, 48%).
3 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
RecallsEighteen outbreaks resulted in product recalls. The foods recalled following a single state outbreak were oysters (3 outbreaks), cheese, cilantro, frozen scallops, masa dough, raw milk, and seaweed and sea asparagus (1 each). Beef (2 outbreaks), alfalfa sprouts, cucumbers, frozen strawberries, hazelnuts, pistachios, raw milk, and shell eggs (1 each) were recalled in multistate outbreaks.
Multistate Outbreaks with First Identified Illness Onset during 2016Thirty-nine multistate outbreaks (5% of all outbreaks) were reported (Table 4), resulting in 1,055 illnesses (7% of illnesses), 283 hospitalizations (32% of hospitalizations), and eight deaths (47% of deaths). These outbreaks involved a median of six states (range: 2–22). Twenty-eight outbreaks were caused by Salmonella; the most frequent serotypes were Enteritidis (4 outbreaks), Newport (4), and Javiana (3). Seven multistate outbreaks were caused by STEC, six of which were due to serogroup O157. Two outbreaks were caused by Listeria, one was caused by HAV, and one was caused by norovirus. The food sources for multistate Salmonella outbreaks were cucumber (2 outbreaks), cantaloupe, chicken, eggs, ground beef, hazelnuts, nuts, peppers, pistachios, prepackaged leafy greens, and salad mix. In addition, alfalfa sprouts, avocado, bean sprouts, chicken, mung bean sprouts, onion, and pork were suspected sources. A food was not identified for nine outbreaks caused by Salmonella. The food sources for STEC outbreaks were beef (two outbreaks) and alfalfa sprouts; iceberg lettuce was suspected in one STEC outbreak, and three did not have a food identified. One of the Listeria outbreak investigations implicated unpasteurized soft cheese and the other did not identify a food. The food implicated in the HAV outbreak was strawberries and the norovirus outbreak had an unidentified food.
Multistate Outbreaks Spanning Multiple YearsNine multistate outbreaks investigated in 2016 were not included in the 2016 tally because the first outbreak-associated illness occurred before 2016. Four were caused by Salmonella; the implicated foods
were chia seed powder (first illness in 2014), alfalfa seeds and sprouts (first illness in 2015), cucumber (first illness in 2015), and moringa leaf powder (first illness in 2015). Three outbreaks were caused by Listeria. The implicated food in one outbreak was prepackaged lettuce. In addition, hummus (first illness is 2013) and smoked fish (first illness in 2014) were suspected sources in two Listeria outbreaks. STEC caused the remaining two outbreaks; the implicated food was flour (first illness in 2015) in one outbreak and pizza dough mix (first illness in 2015) was the suspected source in the other outbreak.
LimitationsThe findings in this report have at least three limitations. First, only a small proportion of foodborne illnesses that occur each year are identified as being associated with outbreaks. The extent to which the distribution of food vehicles and locations of preparation implicated in outbreaks reflect the same vehicles and locations as sporadic foodborne illnesses is unknown. Second, many outbreaks had an unknown etiology, an unknown food vehicle, or both, and conclusions drawn from outbreaks with a confirmed etiology or food vehicle might not apply to other outbreaks. Finally, CDC’s outbreak surveillance system is dynamic. Agencies can submit new reports and change or delete reports as information becomes available. Therefore, the results of this analysis might differ from those in other reports.
References1. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne
illness acquired in the United States—major pathogens.Emerging Infectious Diseases 2011; 17(1): 7–15.
2. Interagency Food Safety Analytics Collaboration(IFSAC): Completed Projects. Available at: http://www.cdc.gov/foodsafety/ifsac/projects/completed.html. Accessed October 13, 2016.
3. Richardson LC, Bazaco MC, Chen Parker C, et al. An updatedscheme for categorizing foods implicated in foodbornedisease outbreaks: a tri-agency collaboration. FoodbornePathogens and Disease 2017; 14(12): 701–710.
4. CDC. Guide to confirming a diagnosis in foodbornedisease. Available at: http://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/confirming_diagnosis.html. Accessed October 13, 2016.
4 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Figure: Rate of reported foodborne disease outbreaks per one million population* and number of outbreaks,† by state‡ and confirmed and suspected etiology§ — Foodborne Disease Outbreak Surveillance System, United States, 2016.
All Outbreaks (N=839)58
698
20
5
37
10
23
8
29
13
12
34 11
66
2815
15298
42 10 8011 30
21
64
69
8
413
32
24
28
4
16
7
7
313
4
10
3
345
3437
4
0.83–2.05Rate2.26–3.573.67–6.406.68–11.20
Note: Full data table for map at https://www.cdc.gov/fdoss/files/All-Outbreaks-2016.csv
5 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Confirmed Bacterial (N=219)23
323
10
3
15
7
14
6
7
10
10
13 5
16
136
6105
19 3
3
197 17
17
238
4
3
6
9
159
23
3
5
3
33
83
6
1612
133
Confirmed Viral (N=149)
8
1
1 6 3
35
1
1
7
433
7
1
1
15 15
6
1
19
5
1
4
1
1
4
12
1
1511
4
0.34–1.131.17–1.781.95–3.193.36–6.40
0.04–0.33Rate
0.34–0.55
No reports
0.61–1.031.05–2.93
Rate
Confirmed Bacterial (N=219)23
323
10
3
15
7
14
6
7
10
10
13 5
16
136
6105
19 3
3
197 17
17
238
4
3
6
9
159
23
3
5
3
33
83
6
1612
133
Confirmed Viral (N=149)
8
1
1 6 3
35
1
1
7
433
7
1
1
15 15
6
1
19
5
1
4
1
1
4
12
1
1511
4
0.34–1.131.17–1.781.95–3.193.36–6.40
0.04–0.33Rate
0.34–0.55
No reports
0.61–1.031.05–2.93
Rate
Suspected Bacterial (N=67)13
1
1 1
11
10 3 1111
1
1
1
2
1
5
23
3
31 1
12
Suspected Viral (N=177)20
1
322
2
6 2
21
20
5
3
4
4
13
5
274
1
1
4
2
2 10
0.08–0.33Rate
0.34–0.60
No reports
0.60–0.920.97–2.74
0.04–0.17Rate
0.17–0.26
No reports
0.33–0.600.64–1.78
6
221
Suspected Bacterial (N=67)13
1
1 1
11
10 3 1111
1
1
1
2
1
5
23
3
31 1
12
Suspected Viral (N=177)20
1
322
2
6 2
21
20
5
3
4
4
13
5
274
1
1
4
2
2 10
0.08–0.33Rate
0.34–0.60
No reports
0.60–0.920.97–2.74
0.04–0.17Rate
0.17–0.26
No reports
0.33–0.600.64–1.78
6
221
*Cut points for outbreak rate categories determined using quartiles. Legend differs for each map. Overlap in quartile ranges are due to rounding.†Reported outbreaks in each state. Puerto Rico reported seven outbreaks and Washington, D.C., reported one outbreak (not shown).‡ Includes 39 multistate outbreaks (i.e., outbreaks in which exposure occurred in more than one state) assigned as an outbreak to each state involved.
Multistate outbreaks involved a median of six states (range: 2–22).§ Guidelines for reporting agencies are to consider an etiology confirmed if it meets confirmation criteria (https://www.cdc.gov/foodsafety/outbreaks/
investigating-outbreaks/confirming_diagnosis.html); otherwise, it is considered suspected. Agents that are not listed in confirmation criteria or that are not known to cause illness are sometimes reported as confirmed or suspected etiologies.
Note: Data table for confirmed bacterial map at https://www.cdc.gov/fdoss/files/Confirmed-Bacterial-2016.csv
Data table for confirmed viral map at https://www.cdc.gov/fdoss/files/Confirmed-Viral-2016.csv
Data table for suspected bacterial map at https://www.cdc.gov/fdoss/files/Suspected-Bacterial-2016.csv
Data table for suspected viral map at https://www.cdc.gov/fdoss/files/Suspected-Viral-2016.csv
6 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Table 1: Foodborne disease outbreaks, outbreak-associated illnesses, and hospitalizations, by etiology (confirmed or suspected)*—Foodborne Disease Outbreak Surveillance System, United States, 2016.
No. Outbreaks No. Illnesses No. Hospitalizations
Etiology CE SE Total % CE SE Total % CE SE Total %
Bacterial
Salmonella† 132 3 135 21 3047 34 3081 25 456 0 456 54
Clostridium perfringens 18 12 30 5 512 244 756 6 3 5 8 1
Escherichia coli, Shiga toxin-producing (STEC)‡ 25 2 27 4 370 16 386 3 98 5 103 12
Campylobacter§ 18 7 25 4 152 35 187 2 17 1 18 2
Bacillus cereus 6 13 19 3 340 301 641 5 0 0 0 0
Staphylococcus aureus enterotoxin 4 10 14 2 173 64 237 2 17 4 21 2
Vibrio parahaemolyticus 3 3 6 1 13 6 19 0 2 0 2 0
Vibrio cholerae 4 1 5 1 8 6 14 0 4 0 4 0
Shigella¶ 2 1 3 0 21 3 24 0 2 0 2 0
Clostridium botulinum 1 1 2 0 2 3 5 0 2 2 4 0
Listeria monocytogenes 2 0 2 0 15 0 15 0 14 0 14 2
Escherichia coli, Enteroinvasive 0 1 1 0 0 23 23 0 0 1 1 0
Staphylococcus spp 1 0 1 0 16 0 16 0 5 0 5 1
Escherichia coli, Enteroaggregative 1 0 1 0 10 0 10 0 0 0 0 0
Brucella spp 1 0 1 0 3 0 3 0 3 0 3 0
Vibrio other 1 0 1 0 2 0 2 0 0 0 0 0
Other 0 13 13 2 0 62 62 1 0 0 0 0
Subtotal 219 67 286 44 4684 797 5481 45 623 18 641 76
Chemical and toxin
Scombroid toxin / Histamine 12 0 12 2 35 0 35 0 0 0 0 0
Ciguatoxin 11 0 11 2 33 0 33 0 3 0 3 0
Mycotoxins 1 0 1 0 7 0 7 0 0 0 0 0
Other 2 1 3 0 66 9 75 1 0 0 0 0
Subtotal 26 1 27 4 141 9 150 1 3 0 3 0
Parasitic
Cryptosporidium 2 0 2 0 9 0 9 0 0 0 0 0
Trichinella 2 0 2 0 8 0 8 0 1 0 1 0
Giardia 0 1 1 0 0 25 25 0 0 0 0 0
Cyclospora 1 0 1 0 15 0 15 0 0 0 0 0
Subtotal 5 1 6 1 32 25 57 0 1 0 1 0
Viral
Norovirus 145 177 322 50 3794 2140 5934 49 44 17 61 7
Hepatitis A virus 3 0 3 0 457 0 457 4 141 0 141 17
Sapovirus 1 0 1 0 15 0 15 0 0 0 0 0
Subtotal 149 177 326 51 4266 2140 6406 53 185 17 202 24
Single etiology** 399 246 645 77 9123 2971 12094 85 812 35 847 97
Multiple etiologies confirmed or suspected†† 4 13 17 2 87 377 464 3 2 2 4 0
Unknown etiology‡‡ 0 177 177 21 0 1701 1701 12 0 24 24 3
Total 403 436 839 100 9210 5049 14259 100 814 61 875 100
Abbreviations: CE = confirmed etiology; SE = suspected etiology.* Guidelines for reporting agencies are to consider an etiology confirmed if it meets confirmation criteria (https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/
confirming_diagnosis.html); otherwise, it is considered suspected. Agents that are not listed in confirmation criteria or that are not known to cause illness are sometimes reported as confirmed or suspected etiologies.
† Salmonella serotypes causing more than five outbreaks were Enteritidis (21 outbreaks), I 4,[5],12:i:- (14), Typhimurium (13), Newport (13), Saintpaul (8), and Javiana (7).‡ STEC serogroups O157 (20 outbreaks), multiple serogroups (2), O5 (1), O121 (1), O111 (1), O26 (1), and unknown serogroup (1).§ Campylobacter jejuni (14 outbreaks), Campylobacter unknown species (9), Campylobacter coli (1), and Campylobacter multiple species (1).¶ Shigella sonnei (3 outbreaks).** The denominator for the etiology percentages is the single etiology total. The denominator for the single etiology, multiple etiologies, and unknown etiology is the total.
Because of rounding, numbers might not add up to the single etiology total or the total.†† If at least two etiologies are confirmed in an outbreak, it is considered a confirmed multiple etiology outbreak; otherwise it is considered a suspected multiple etiology outbreak.‡‡ An etiologic agent was not confirmed or suspected based on clinical, laboratory, or epidemiologic information.
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Table 2a: Foodborne disease outbreaks and outbreak-associated illnesses, by food category*—Foodborne Disease Outbreak Surveillance System, United States, 2016.
No. Outbreaks No. Illnesses
Food Category* Total % Total %
Aquatic animals
Crustaceans 6 3 118 3
Mollusks† 21 12 529 14
Fish 26 14 82 2
Other aquatic animals 2 1 8 0
Subtotal 55 31 737 20
Land animals
Dairy‡ 19 11 252 7
Eggs 6 3 161 4
Beef 11 6 340 9
Pork 18 10 438 12
Other meat (sheep, goat, etc.) 1 1 50 1
Chicken 17 9 356 9
Turkey 3 2 62 2
Game 1 1 3 0
Subtotal 76 42 1662 44
Plants
Oils and sugars 1 1 12 0
Fungi 1 1 7 0
Sprouts 5 3 104 3
Root and other underground vegetables§ 3 2 118 3
Seeded vegetables¶ 6 3 106 3
Herbs 1 1 96 3
Vegetable row crops** 7 4 144 4
Fruits†† 10 6 347 9
Grains and beans‡‡ 8 4 383 10
Nuts and seeds§§ 3 2 22 1
Subtotal 45 25 1339 35
Other 11 6 247 6
Food reported, attributed to a single food category¶¶ 180 21 3776 26
Food reported, not attributed to a single food category 143 17 2939 21
No food reported 516 62 7544 53
Total¶¶ 839 100 14259 100
* Interagency Food Safety Analytics Collaboration (IFSAC) food categorization scheme: http://www.cdc.gov/foodsafety/ifsac/projects/completed.html.† Bivalve mollusks (20 outbreaks) and non-bivalve mollusks (1).‡ Unpasteurized dairy products (19 outbreaks).§ Bulbs (1 outbreak), roots (1), and tubers (1).¶ Vine-grown seeded vegetables (4 outbreaks), other seeded vegetables (1), and solanaceous seeded vegetables (1).** Leafy vegetables (6 outbreaks) and vegetable row crops not further classified (1).†† Sub-tropical fruits (3 outbreaks), fruits not further classified (2), melons (2), small fruits (2), and pome fruits (1).‡‡ Grains (5 outbreaks) and beans (3).§§ Nuts (3 outbreaks).¶¶ The denominator for the food category percentages is the “food reported, attributed to a single food category” total. The denominator for the “food reported attributed to
a single food category,” “food reported, not attributed to a single food category,” and “no food reported” is the total. Because of rounding, numbers might not add up to the “food reported, attributed to a single food category” total or the total.
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Table 2b: Most common pathogen-food category pairs resulting in outbreaks, outbreak-associated illnesses, hospitalizations, and deaths—Foodborne Disease Outbreak Surveillance System, United States, 2016.
Top 5 pathogen-food category pairs resulting in outbreaks
Etiology Food Category* No. Outbreaks No. Illnesses No. Hospitalizations No. Deaths
Scombroid toxin/histamine Fish 12 35 0 0
Ciguatoxin Fish 11 33 3 0
Salmonella Chicken 8 307 42 1
Campylobacter Dairy 7 57 5 0
Norovirus Mollusks 6 209 3 0
Salmonella Pork 6 96 12 0
Vibrio parahaemolyticus Mollusks 6 19 2 0
Top 5 pathogen-food category pairs resulting in outbreak-associated illnesses
Etiology Food Category* No. Outbreaks No. Illnesses No. Hospitalizations No. Deaths
Grains and beans 5 348 0 0
Chicken 8 307 42 1
Mollusks 1 281 71 2
Mollusks 6 209 3 0
Bacillus cereus
Salmonella
Hepatitis A virus
Norovirus
Staphylococcus aureus enterotoxin Pork 4 170 18 0
Top 5 pathogen-food category pairs resulting in outbreak-associated hospitalizations
Etiology Food Category* No. Outbreaks No. Illnesses No. Hospitalizations No. Deaths
Hepatitis A virus Mollusks 1 281 71 2
Hepatitis A virus Fruits 1 137 57 0
Salmonella Beef 2 110 44 1
Salmonella Chicken 8 307 42 1
Salmonella Dairy 4 138 23 0
Pathogen-food category pairs resulting in outbreak-associated deaths
Etiology Food Category* No. Outbreaks No. Illnesses No. Hospitalizations No. Deaths
Mollusks 1 281 71 2
Dairy 1 10 9 2
Chicken 8 307 42 1
Mollusks 3 6 3 1
Hepatitis A virus
Listeria monocytogenes
Salmonella
Vibrio cholerae
Salmonella Beef 2 110 44 1
Interagency Food Safety Analytics Collaboration (IFSAC) food categorization scheme: http://www.cdc.gov/foodsafety/ifsac/projects/completed.html.
9 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Table 3a: Foodborne disease outbreaks and outbreak-associated illnesses, by location of food preparation—Foodborne Disease Outbreak Surveillance System, United States, 2016.
No. Outbreaks No. Illnesses
Location Total % Total %
Restaurant 459 61 5353 42
Sit-down dining 363 48 4139 33
Fast-food 62 8 768 6
Buffet 16 2 240 2
Other or unknown type 24 3 374 3
Multiple types 10 1 72 1
Catering or banquet facility 102 14 3116 25
Private home 76 10 895 7
Institutional location 21 3 1377 11
School 8 1 785 6
Prison or jail 5 1 437 3
Camp 4 1 56 0
Day Care 2 0 46 0
Office or indoor workplace 2 0 53 0
Other location 7 1 113 1
Other commercial location 40 5 723 6
Grocery store 15 2 239 2
Fair, festival, or temporary mobile service 13 2 290 2
Farm or dairy 11 1 192 2
Other 1 0 2 0
Hospital or nursing home 16 2 412 3
Nursing home 16 2 412 3
Other private location 7 1 234 2
Place of worship 6 1 224 2
Other 1 0 10 0
Hotel or motel 7 1 159 1
Single location* 751 90 12622 89
Multiple locations 40 5 830 6
Unknown location 48 6 807 6
Total 839 100 14259 100
* The denominator for the location percentages is the single location total. The denominator for the single location, multiple locations, and unknown location is the total. Because of rounding, numbers might not add up to the single location total or the total.
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Table 3b: Foodborne disease outbreaks and outbreak-associated illnesses, by confirmed etiology* and location of food preparation†—Foodborne Disease Outbreak Surveillance System, United State, 2016.
Catering or banquet facility
RestaurantOther
commercial location
Hospital or nursing home
Institutional location
Private home
Other private
location
Other location
Etiology NO NI NO NI NO NI NO NI NO NI NO NI NO NI NO NI
Bacterial
Salmonella 6 255 53 794 11 363 3 11 10 507 17 310 2 51 1 2
Clostridium perfringens 3 106 9 255 –‡ – – – – – 3 72 1 35 – –
Escherichia coli, Shiga toxin-producing 1 10 7 46 4 60 – – – – 2 14 – – – –
Campylobacter 2 20 8 85 4 37 – – – – 3 7 – – – –
Bacillus cereus 1 39 2 187 – – – – 2 110 1 4 – – – –
Staphylococcus aureus enterotoxin 2 157 1 4 – – – – – – 1 12 – – – –
Vibrio parahaemolyticus – – – – 1 2 – – – – – – – – – –
Vibrio cholerae – – 2 4 1 2 – – – – – – – – – –
Shigella 2 21 – – – – – – – – – – – – – –
Clostridium botulinum – – – – – – – – – – 1 2 – – – –
Listeria monocytogenes – – – – – – – – – – – – – – – –
Escherichia coli, Enteroinvasive – – – – – – – – – – – – – – – –
Staphylococcus spp – – 1 16 – – – – – – – – – – – –
Escherichia coli, Enteroaggregative – – – – 1 10 – – – – – – – – – –
Brucella spp – – – – – – – – – – 1 3 – – – –
Vibrio other – – 1 2 – – – – – – – – – – – –
Other – – – – – – – – – – – – – – – –
Subtotal 17 608 84 1393 22 474 3 11 12 617 29 424 3 86 1 2
Chemical and toxin
Scombroid toxin/histamine – – 9 29 – – – – – – 3 6 – – – –
Ciguatoxin – – – – 1 2 – – – – 9 25 – – – –
Mycotoxins – – – – – – – – – – 1 7 – – – –
Other 1 64 – – – – – – – – – – – – 1 2
Subtotal 1 64 9 29 1 2 – – – – 13 38 – – 1 2
Parasitic
Cryptosporidium – – – – 2 9 – – – – – – – – – –
Trichinella – – – – – – – – – – 2 8 – – – –
Giardia – – – – – – – – – – – – – – – –
Cyclospora – – 1 15 – – – – – – – – – – – –
Subtotal – – 1 15 2 9 – – – – 2 8 – – – –
Viral
Norovirus 28 1051 85 1426 2 93 5 187 2 529 5 60 2 100 3 112
Hepatitis A virus – – 2 418 – – – – – – 1 39 – – – –
Sapovirus – – 1 15 – – – – – – – – – – – –
Subtotal 28 1051 88 1859 2 93 5 187 2 529 6 99 2 100 3 112
Single etiology 46 1723 182 3296 27 578 8 198 14 1146 51 581 5 186 6 128
Multiple etiologies confirmed§ – – 2 22 – – – – – – 2 65 – – – –
Total 46 1723 184 3318 27 578 8 198 14 1146 53 646 5 186 6 128
Abbreviations: NO = number of outbreaks; NI = number of illnesses; CE = confirmed etiology, SE = suspected etiology.* Guidelines for reporting agencies are to consider an etiology confirmed if it meets confirmation criteria (https://www.cdc.gov/foodsafety/outbreaks/investigating-
outbreaks/confirming_diagnosis.html); otherwise, it is considered suspected. Agents that are not listed in confirmation criteria or that are not known to cause illness are sometimes reported as confirmed or suspected etiologies.
† Reported locations were grouped as follows: catering or banquet facility, restaurant, other commorcial location, hospital or nursing home, other institutional location, private home, other private location, and other location (see Table 3a).
‡ No outbreaks in the data reported fall into this category.§ If at least two etiologies are confirmed in an outbreak, it is considered a confirmed multiple etiology outbreak; otherwise it is considered a suspected multiple etiology
outbreak.
11 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Table 3c: Foodborne disease outbreaks and outbreak-associated illnesses, by suspected etiology* and location of food preparation—Foodborne Disease Outbreak Surveillance System, United State, 2016.
Catering or banquet facility
RestaurantOther
commercial location
Hospital or nursing home
Institutional location
Private home
Other private
location
Other location
Etiology NO NI NO NI NO NI NO NI NO NI NO NI NO NI NO NI
Bacterial
Salmonella 1 25 1 7 – ‡ – – – – – – – – – – –
Clostridium perfringens 7 121 2 11 1 11 – – – – 1 17 – – – –
Escherichia coli, Shiga toxin-producing – – – – – – – – – – 2 16 – – – –
Campylobacter – – 2 6 1 6 – – – – 1 15 – – – –
Bacillus cereus 3 260 9 38 – – – – – – – – – – – –
Staphylococcus aureus enterotoxin – – 7 23 – – – – – – 2 29 – – 1 12
Vibrio parahaemolyticus – – 2 4 – – – – – – 1 2 – – – –
Vibrio cholerae – – 1 6 – – – – – – – – – – – –
Shigella – – – – – – – – 1 3 – – – – – –
Clostridium botulinum – – – – – – – – – – 1 3 – – – –
Listeria monocytogenes – – – – – – – – – – – – – – – –
Escherichia coli, Enteroinvasive 1 23 – – – – – – – – – – – – – –
Staphylococcus spp – – – – – – – – – – – – – – – –
Escherichia coli, Enteroaggregative – – – – – – – – – – – – – – – –
Brucella spp – – – – – – – – – – – – – – – –
Vibrio other – – – – – – – – – – – – – – – –
Other 1 26 11 34 1 2 – – – – – – – – – –
Subtotal 13 455 35 129 3 19 – – 1 3 8 82 – – 1 12
Chemical and toxin
Scombroid toxin/histamine – – – – – – – – – – – – – – – –
Ciguatoxin – – – – – – – – – – – – – – – –
Mycotoxins – – – – – – – – – – – – – – – –
Other 1 9 – – – – – – – – – – – – – –
Subtotal 1 9 – – – – – – – – – – – – – –
Parasitic
Cryptosporidium – – – – – – – – – – – – – – – –
Trichinella – – – – – – – – – – – – – – – –
Giardia – – – – – – – – – – – – – – – –
Cyclospora – – – – – – – – – – – – – – – –
Subtotal – – – – – – – – – – – – – – – –
Viral
Norovirus 14 459 127 1058 6 86 3 121 3 94 5 51 1 8 6 121
Hepatitis A virus – – – – – – – – – – – – – – – –
Sapovirus – – – – – – – – – – – – – – – –
Subtotal 14 459 127 1058 6 86 3 121 3 94 5 51 1 8 6 121
Single etiology 28 923 163 1392 9 105 3 121 4 97 13 133 1 8 7 133
Multiple etiologies suspected§ 2 17 5 32 – – – – 1 68 2 28 – – – –
Unknown etiology¶ 26 453 107 611 4 40 5 93 2 66 8 88 1 40 1 11
Total 56 1393 275 2035 13 145 8 214 7 231 23 249 2 48 8 144
Abbreviations: NO = number of outbreaks; NI = number of illnesses; CE = confirmed etiology, SE = suspected etiology.* Guidelines for reporting agencies are to consider an etiology confirmed if it meets confirmation criteria (https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/
confirming_diagnosis.html); otherwise, it is considered suspected. Agents that are not listed in confirmation criteria or that are not known to cause illness are sometimes reported as confirmed or suspected etiologies.
† Reported locations were grouped as follows: catering or banquet facility, restaurant, other commorcial location, hospital or nursing home, other institutional location, private home, other private location, and other location (see Table 3a).
‡ No outbreaks in the data reported fall into this category.§ If at least two etiologies are confirmed in an outbreak, it is considered a confirmed multiple etiology outbreak; otherwise it is considered a suspected multiple etiology outbreak.¶ An etiologic agent was not confirmed or suspected based on clinical, laboratory, or epidemiologic information.
12 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Table 4: Multistate foodborne disease outbreaks—Foodborne Disease Outbreak Surveillance System, United States, 2016.
Implicated food*
Month of first illness onset Etiology
No. illnesses
No. hospitalizations
No. deaths
No. states involved Name Confirmed Recall
January Salmonella Montevideo; Senftenberg 11 2 0 9 Pistachios Yes Yes
January Shiga toxin-producing E. coli O157:NM (H-) 11 2 0 2 Alfalfa sprouts Yes Yes
March Salmonella Sundsvall 6 1 0 2 No food reported – No
March Salmonella Oslo 14 3 0 8 Cucumbers Yes No
April Salmonella Goldcoast 12 1 0 5 Pork No No
April Shiga toxin-producing E. coli O5 4 0 0 4 No food reported – No
April Salmonella Bareilly 21 3 0 7 No food reported – No
April Salmonella Braenderup 32 6 0 14 Mung bean sprouts No No
April Salmonella Enteritidis 7 0 0 2 Prepackaged leafy greens Yes No
April Salmonella Oranienburg 8 2 0 3 Shell Eggs Yes Yes
May Hepatitis A virus 137 57 0 9 Strawberries Yes Yes
May Salmonella Reading; Abony 36 7 0 9 Alfalfa sprouts Yes No
May Salmonella Enteritidis 59 7 0 19 Avocado No No
May Salmonella Anatum 32 8 0 9 Peppers Yes No
May Salmonella Javiana 29 6 0 8 Onion No No
June Salmonella Enteritidis 28 7 0 6 Salad mix Yes No
June Salmonella Minnesota 10 3 0 8 Cantaloupe Yes No
June Salmonella Javiana 17 3 0 6 No food reported – No
June Shiga toxin-producing E. coli O157:H7 14 5 0 3 Beef Yes Yes
June Salmonella Saintpaul 10 3 0 3 Cucumber Yes Yes
June Shiga toxin-producing E. coli O157:H7 11 4 0 3 Iceberg lettuce No No
June Salmonella I 4,[5],12:i:- 5 2 0 2 Nuts No No
June Shiga toxin-producing E. coli O157 11 7 0 5 Ground beef Yes Yes
July Salmonella I 4,[5],12:i:- 64 16 0 13 Chicken Yes No
July Salmonella Javiana 45 9 0 19 No food reported – No
July Salmonella Saintpaul 70 12 0 11 Chicken No No
August Salmonella Newport 12 4 0 5 No food reported – No
August Salmonella Newport 53 9 1 17 No food reported – No
September Listeria monocytogenes 5 5 1 3 No food reported – No
September Listeria monocytogenes 10 9 2 5 Unpasteurized soft cheese Yes Yes
September Shiga toxin-producing E. coli O157:H7 20 7 2 6 No food reported – No
October Salmonella Enteritidis 20 3 0 7 Bean sprouts No No
October Salmonella Newport 107 43 1 22 Ground beef Yes No
October Salmonella Typhimurium 6 1 0 2 Hazelnuts Yes Yes
October Shiga toxin-producing E. coli O157 13 10 1 5 No food reported – No
November Salmonella Montevideo 19 2 0 6 No food reported – No
November Salmonella Newport 25 9 0 8 No food reported – No
December Salmonella Goldcoast 16 5 0 14 No food reported – No
December Norovirus GII.4 untypeable 45 0 0 2 No food reported – No
* Implicated foods in multistate outbreaks are further classified as confirmed or suspected based on epidemiologic, traceback, and laboratory evidence. A food is considered the confirmed source if two types of evidence are obtained, while a food is considered suspected if only one type of evidence is available.
13 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Appendix Table 1: Foodborne disease outbreaks by confirmed etiology* and contributing factors†—Foodborne Disease Outbreak Surveillance System, United States, 2016.
Contamination Factors Outbreaks with reported contributing
factors
Total outbreaks
Etiology C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12 C13 C14 C15 ≥1 factor reported
Bacterial
Salmonella 1 –§ – – – 12 11 3 21 3 3 2 3 4 4 41 48 132
Clostridium perfringens 1 – – – – 2 – – 1 – – – – 3 2 9 15 18
Escherichia coli, Shiga toxin-producing 1 – – – – 1 5 – 5 1 – 1 – 4 2 11 12 25
Campylobacter – – – – – 2 7 1 2 1 1 1 – – 1 10 10 18
Bacillus cereus – – – – – 1 – – – – – – – – – 1 5 6
Staphylococcus aureus enterotoxin – – – – – 1 – – 2 – – – – – 1 3 4 4
Vibrio parahaemolyticus – – – – – – 1 1 – – – – – – – 1 2 3
Vibrio cholerae – – – – – – 3 – – – – – – – – 3 3 4
Shigella – – – – – – 1 – 1 – – – – – – 1 1 2
Clostridium botulinum – – – – – – – – – – – – – – – – 1 1
Listeria monocytogenes – – – – – – – – – – – – – – – – – 2
Escherichia coli, Enteroinvasive – – – – – – – – – – – – – – – – – –
Staphylococcus spp – – – – – – – – – 1 – – – – – 1 1 1
Escherichia coli, Enteroaggregative – – – – – – – – – – – – – – – – – 1
Brucella spp 1 – – – – – – – – – – – – – – 1 1 1
Vibrio other – – – – – – – – 1 – – – – 1 1 1 1 1
Other – – – – – – – – – – – – – – – – – –
Subtotal 4 – – – – 19 28 5 33 6 4 4 3 12 11 83 104 219
Chemical and toxin
Scombroid toxin/histamine 9 – – – – – 2 – 1 – – – – – – 10 10 12
Ciguatoxin 11 – – – – – – – – – – – – – – 11 11 11
Mycotoxins – – 1 – – – – – – – – – – – – 1 1 1
Other – – – 1 – – – – – – – – – – 1 1 1 2
Subtotal 20 – 1 1 – – 2 – 1 – – – – – 1 23 23 26
Parasitic
Cryptosporidium – – – – – – 2 – – – – – – – – 2 2 2
Trichinella 1 – – – – 1 – – – – – – – – – 2 2 2
Giardia – – – – – – – – – – – – – – – – – –
Cyclospora – – – – – – – – – – – – – – – – – 1
Subtotal 1 – – – – 1 2 – – – – – – – – 4 4 5
Viral
Norovirus 1 – – – – 1 6 2 2 32 24 38 10 1 3 83 84 145
Hepatitis A virus – – – – – – 2 – 1 – – – 1 – – 3 3 3
Sapovirus – – – – – – – – – – – – – – – – – 1
Subtotal 1 – – – – 1 8 2 3 32 24 38 11 1 3 86 87 149
Single etiology 26 – 1 1 – 21 40 7 37 38 28 42 14 13 15 196 218 399
Multiple etiologies confirmed – – – – – 1 – – – 1 – 1 – – – 2 2 4
Total 26 – 1 1 – 22 40 7 37 39 28 43 14 13 15 198 220 403
Footnotes are on page 19.
14 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Appendix Table 2: Foodborne disease outbreaks by confirmed etiology* and contributing factors†—Foodborne Disease Outbreak Surveillance System, United States, 2016.
Proliferation / Amplification Factors Outbreaks with reported contributing
factors
Total outbreaks
Etiology P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 ≥1 factor reported
Bacterial
Salmonella 21 10 3 5 6 –§ 7 6 – 1 1 2 35 48 132
Clostridium perfringens 7 5 – 2 6 – 10 7 – – – 1 14 15 18
Escherichia coli, Shiga toxin-producing 4 1 1 1 3 1 1 2 – – – – 5 12 25
Campylobacter 1 – – 1 – – – 1 – – – 1 2 10 18
Bacillus cereus 2 – – – 1 – – – – – – – 2 5 6
Staphylococcus aureus enterotoxin 2 2 1 – – – – – – – – – 4 4 4
Vibrio parahaemolyticus – – – – – – – – – – – 1 1 2 3
Vibrio cholerae – 1 – – – – 1 – – – – – 2 3 4
Shigella – 1 – – – – – – – – – – 1 1 2
Clostridium botulinum – – – – – – – – – 1 1 – 1 1 1
Listeria monocytogenes – – – – – – – – – – – – – – 2
Escherichia coli, Enteroinvasive – – – – – – – – – – – – – – –
Staphylococcus spp – – – – – 1 – 1 – – – – 1 1 1
Escherichia coli, Enteroaggregative – – – – – – – – – – – – – – 1
Brucella spp 1 – – – – – – – – – – – 1 1 1
Vibrio other – – – – – – – – – – – – – 1 1
Other – – – – – – – – – – – – – – –
Subtotal 38 20 5 9 16 2 19 17 – 2 2 5 69 104 219
Chemical and toxin
Scombroid toxin/histamine – – – 2 2 – – – – – – – 4 10 12
Ciguatoxin – – – – – – – – – – – – – 11 11
Mycotoxins – – – – – – – – – – – – – 1 1
Other – – – – – – – – – – – – – 1 2
Subtotal – – – 2 2 – – – – – – – 4 23 26
Parasitic
Cryptosporidium – – – – – – – – – – – – – 2 2
Trichinella – – – – – – – – – – – – – 2 2
Giardia – – – – – – – – – – – – – – –
Cyclospora – – – – – – – – – – – – – – 1
Subtotal – – – – – – – – – – – – – 4 5
Viral
Norovirus – 1 – – – – – – – – – – 1 84 145
Hepatitis A virus – 1 – – – – – – – – – – 1 3 3
Sapovirus – – – – – – – – – – – – – – 1
Subtotal – 2 – – – – – – – – – – 2 87 149
Single etiology 38 22 5 11 18 2 19 17 – 2 2 5 75 218 399
Multiple etiologies confirmed – – – – – – – – – – – – – 2 4
Total 38 22 5 11 18 2 19 17 – 2 2 5 75 220 403
Footnotes are on page 19.
15 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Appendix Table 3: Foodborne disease outbreaks by confirmed etiology* and contributing factors—Foodborne Disease Outbreak Surveillance System, United States, 2016.
Survival Factors Outbreaks with reported contributing
factors
Total outbreaks
Etiology S1 S2 S3 S4 S5 ≥1 factor reported
Bacterial
Salmonella 14 6 1 3 4 23 48 132
Clostridium perfringens 2 8 1 –§ 2 10 15 18
Escherichia coli, Shiga toxin-producing 2 1 – 2 4 7 12 25
Campylobacter 4 – – – – 4 10 18
Bacillus cereus 1 2 – – 1 4 5 6
Staphylococcus aureus enterotoxin 1 – – – 1 2 4 4
Vibrio parahaemolyticus 1 – – – – 1 2 3
Vibrio cholerae 1 – – – 1 2 3 4
Shigella – – – – – – 1 2
Clostridium botulinum 1 – – – – 1 1 1
Listeria monocytogenes – – – – – – – 2
Escherichia coli, Enteroinvasive – – – – – – – –
Staphylococcus spp – – – – – – 1 1
Escherichia coli, Enteroaggregative – – – – – – – 1
Brucella spp – – – – 1 1 1 1
Vibrio other – – – – – – 1 1
Other – – – – – – – –
Subtotal 27 17 2 5 14 55 104 219
Chemical and toxin
Scombroid toxin/histamine 1 – – – – 1 10 12
Ciguatoxin – – – – – – 11 11
Mycotoxins – – – – – – 1 1
Other – – – – – – 1 2
Subtotal 1 – – – – 1 23 26
Parasitic
Cryptosporidium – – – – – – 2 2
Trichinella 2 – – – – 2 2 2
Giardia – – – – – – – –
Cyclospora – – – – – – – 1
Subtotal 2 – – – – 2 4 5
Viral
Norovirus 2 1 – 2 4 7 84 145
Hepatitis A virus – – – – – – 3 3
Sapovirus – – – – – – – 1
Subtotal 2 1 – 2 4 7 87 149
Single etiology 32 18 2 7 18 65 218 399
Multiple etiologies confirmed 1 – – – – 1 2 4
Total 33 18 2 7 18 66 220 403
Footnotes are on page 19.
16 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Appendix Table 4: Foodborne disease outbreaks by suspected etiology* and contributing factors†—Foodborne Disease Outbreak Surveillance System, United States, 2016.
Contamination Factors Outbreaks with reported contributing
factors
Total outbreaks
Etiology C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12 C13 C14 C15 ≥1 factor reported
Bacterial
Salmonella –§ – – – – – – – 1 – – – – – – 1 1 3
Clostridium perfringens 1 – – – – 1 – – – – – 1 – 1 1 3 7 12
Escherichia coli, Shiga toxin-producing – – – – – – 1 – – – – – – – – 1 1 2
Campylobacter – – – – – 1 1 – 1 – – – – – – 3 3 7
Bacillus cereus 1 – – – – 1 – – 2 – – – – 1 1 6 9 13
Staphylococcus aureus enterotoxin – – – – – – – – 1 1 – – 1 – – 3 6 10
Vibrio parahaemolyticus – – – – – – 1 1 – – – – – – – 1 3 3
Vibrio cholerae – – – – – – 1 – – – – – – – – 1 1 1
Shigella – – – – – – – – – – – – – 1 – 1 1 1
Clostridium botulinum – – – – – – – – – – – – – – – – 1 1
Listeria monocytogenes – – – – – – – – – – – – – – – – – –
Escherichia coli, Enteroinvasive – – – – – – – – – – – – – – – – – 1
Staphylococcus spp – – – – – – – – – – – – – – – – – –
Escherichia coli, Enteroaggregative – – – – – – – – – – – – – – – – – –
Brucella spp – – – – – – – – – – – – – – – – – –
Vibrio other – – – – – – – – – – – – – – – – – –
Other – – – – – – – – 2 – – – – – 2 3 7 13
Subtotal 2 – – – – 3 4 1 7 1 – 1 1 3 4 23 40 67
Chemical and toxin
Scombroid toxin/histamine – – – – – – – – – – – – – – – – – –
Ciguatoxin – – – – – – – – – – – – – – – – – –
Mycotoxins – – – – – – – – – – – – – – – – – –
Other – – – – – – – – – – – – – – – – – 1
Subtotal – – – – – – – – – – – – – – – – – 1
Parasitic
Cryptosporidium – – – – – – – – – – – – – – – – – –
Trichinella – – – – – – – – – – – – – – – – – –
Giardia – – – – – – – – – – – – – – – – – 1
Cyclospora – – – – – – – – – – – – – – – – – –
Subtotal – – – – – – – – – – – – – – – – – 1
Viral
Norovirus – – – – – – – – 8 35 30 18 7 8 20 71 72 177
Hepatitis A virus – – – – – – – – – – – – – – – – – –
Sapovirus – – – – – – – – – – – – – – – – – –
Subtotal – – – – – – – – 8 35 30 18 7 8 20 71 72 177
Single etiology 2 – – – – 3 4 1 15 36 30 19 8 11 24 94 112 246
Multiple etiologies suspected 1 – – – – 1 – – – – – – – – 2 4 5 13
Unknown etiology¶ 2 – – – – 1 2 1 10 9 5 2 3 7 7 29 42 177
Total 5 – – – – 5 6 2 25 45 35 21 11 18 33 127 159 436
Footnotes are on page 19.
17 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Appendix Table 5: Foodborne disease outbreaks by suspected etiology* and contributing factors†—Foodborne Disease Outbreak Surveillance System, United States, 2016.
Proliferation / Amplification Factors Outbreaks with reported contributing
factors
Total outbreaks
Etiology P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 ≥1 factor reported
Bacterial
Salmonella 1 –§ – – – – – – – – – – 1 1 3
Clostridium perfringens 3 4 1 1 2 1 3 5 – – – – 7 7 12
Escherichia coli, Shiga toxin-producing – – – – – – – – – – – – – 1 2
Campylobacter 1 – – – 1 – 1 – – – – – 2 3 7
Bacillus cereus 5 5 1 – 4 – 2 4 – – – 1 9 9 13
Staphylococcus aureus enterotoxin 2 5 – 1 3 – 3 1 – 1 – 1 6 6 10
Vibrio parahaemolyticus – – – – – – – – – – – 2 2 3 3
Vibrio cholerae – – – – – – – – – – 1 – 1 1 1
Shigella – – – – – – – – – – – – – 1 1
Clostridium botulinum – – – – – – – – – – – 1 1 1 1
Listeria monocytogenes – – – – – – – – – – – – – – –
Escherichia coli, Enteroinvasive – – – – – – – – – – – – – – 1
Staphylococcus spp – – – – – – – – – – – – – – –
Escherichia coli, Enteroaggregative – – – – – – – – – – – – – – –
Brucella spp – – – – – – – – – – – – – – –
Vibrio other – – – – – – – – – – – – – – –
Other 2 4 – 3 1 – 2 4 – – 1 – 7 7 13
Subtotal 14 18 2 5 11 1 11 14 – 1 2 5 36 40 67
Chemical and toxin
Scombroid toxin/histamine – – – – – – – – – – – – – – –
Ciguatoxin – – – – – – – – – – – – – – –
Mycotoxins – – – – – – – – – – – – – – –
Other – – – – – – – – – – – – – – 1
Subtotal – – – – – – – – – – – – – – 1
Parasitic
Cryptosporidium – – – – – – – – – – – – – – –
Trichinella – – – – – – – – – – – – – – –
Giardia – – – – – – – – – – – – – – 1
Cyclospora – – – – – – – – – – – – – – –
Subtotal – – – – – – – – – – – – – – 1
Viral
Norovirus – – – – 1 – – – – – – – 1 72 177
Hepatitis A virus – – – – – – – – – – – – – – –
Sapovirus – – – – – – – – – – – – – – –
Subtotal – – – – 1 – – – – – – – 1 72 177
Single etiology 14 18 2 5 12 1 11 14 – 1 2 5 37 112 246
Multiple etiologies suspected 3 1 – – – – 2 – – – – – 4 5 13
Unknown etiology¶ 8 11 5 7 12 – 9 3 – – – 3 31 42 177
Total 25 30 7 12 24 1 22 17 – 1 2 8 72 159 436
Footnotes are on page 19.
18 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Appendix Table 6: Foodborne disease outbreaks by suspected etiology* and contributing factors†—Foodborne Disease Outbreak Surveillance System, United States, 2016.
Survival Factors Outbreaks with reported contributing
factors
Total outbreaks
Etiology S1 S2 S3 S4 S5 ≥1 factor reported
Bacterial
Salmonella –§ – – – 1 1 1 3
Clostridium perfringens 2 4 – – – 5 7 12
Escherichia coli, Shiga toxin-producing – – – – – – 1 2
Campylobacter 1 – – – – 1 3 7
Bacillus cereus 3 1 – – 4 6 9 13
Staphylococcus aureus enterotoxin – 2 – – 1 3 6 10
Vibrio parahaemolyticus – – – – – – 3 3
Vibrio cholerae – – – 1 – 1 1 1
Shigella – – – – – – 1 1
Clostridium botulinum – – – – 1 1 1 1
Listeria monocytogenes – – – – – – – –
Escherichia coli, Enteroinvasive – – – – – – – 1
Staphylococcus spp – – – – – – – –
Escherichia coli, Enteroaggregative – – – – – – – –
Brucella spp – – – – – – – –
Vibrio other – – – – – – – –
Other 1 2 – 2 2 5 7 13
Subtotal 7 9 – 3 9 23 40 67
Chemical and toxin
Scombroid toxin/histamine – – – – – – – –
Ciguatoxin – – – – – – – –
Mycotoxins – – – – – – – –
Other – – – – – – – 1
Subtotal – – – – – – – 1
Parasitic
Cryptosporidium – – – – – – – –
Trichinella – – – – – – – –
Giardia – – – – – – – 1
Cyclospora – – – – – – – –
Subtotal – – – – – – – 1
Viral
Norovirus 1 – – 2 2 5 72 177
Hepatitis A virus – – – – – – – –
Sapovirus – – – – – – – –
Subtotal 1 – – 2 2 5 72 177
Single etiology 8 9 – 5 11 28 112 246
Multiple etiologies suspected 2 1 – – – 2 5 13
Unknown etiology¶ 5 5 – 1 2 13 42 177
Total 15 15 – 6 13 43 159 436
Footnotes are on page 19.
19 Surveillance for Foodborne Disease Outbreaks, United States 2016 | Annual Report
Appendix: Reported foodborne disease outbreaks, by confirmed and suspected etiology* and contributing factors†—Foodborne Disease Outbreak Surveillance System, United States, 2016* Guidelines for reporting agencies are to consider an etiology confirmed if it meets confirmation criteria (https://www.cdc.gov/foodsafety/outbreaks/investigating-
outbreaks/confirming_diagnosis.html); otherwise, it is considered suspected. Agents that are not listed in confirmation criteria or that are not known to cause illness are sometimes reported as confirmed or suspected etiologies. If at least two etiologies are confirmed in an outbreak, it is considered a confirmed multiple etiology outbreak; otherwise it is considered a suspected multiple etiology outbreak.
† Contributing factors are defined as risk factors that either enable an outbreak to occur or amplify an outbreak caused by other means. Contributing factors are classified into three categories: contamination factors (factors that introduce or otherwise permit contamination), proliferation/amplification factors (factors that allow proliferation or growth of the etiologic agent), and survival factors (factors that allow survival or fail to inactivate a contaminant). More than one contributing factor might be reported per outbreak.
‡ Contributing factors:
C1: toxic substance part of the tissue
C2: poisonous substance intentionally/deliberately added
C3: poisonous substance accidentally/inadvertently added
C4: addition of excessive quantities of ingredients that are toxic in large amounts
C5: toxic container
C6: contaminated raw product—food that was intended to be consumed after a kill step
C7: contaminated raw product—food was intended to be consumed raw or undercooked/underprocessed
C8: foods originating from sources shown to be contaminated or polluted (such as a growing field or harvest area)
C9: cross-contamination of ingredients (cross-contamination does not include ill food workers)
C10: bare-handed contact by a food handler/worker/preparer who is suspected to be infectious
C11: glove-handed contact by a food handler/worker/preparer who is suspected to be infectious
C12: other mode of contamination (excluding cross-contamination) by a food handler/worker/preparer who is suspected to be infectious
C13: foods contaminated by non-food handler/worker/preparer who is suspected to be infectious
C14: storage in a contaminated environment
C15: other source of contamination
P1: food preparation practices that support proliferation of pathogens (during food preparation)
P2: no attempt was made to control the temperature of implicated food or the length of time food was out of temperature control (during food service or display of food)
P3: improper adherence of approved plan to use Time as a Public Health Control
P4: improper cold holding due to malfunctioning refrigeration equipment
P5: improper cold holding due to an improper procedure or protocol
P6: improper hot holding due to malfunctioning equipment
P7: improper hot holding due to improper procedure or protocol
P8: improper/slow cooling
P9: prolonged cold storage
P10: inadequate modified atmospheric packaging
P11: inadequate processing (acidification, water activity, fermentation)
P12: other situations that promoted or allowed microbial growth or toxin production
S1: insufficient time and/or temperature control during initial cooking/heat processing
S2: insufficient time and/or temperature during reheating
S3: insufficient time and/or temperature control during freezing
S4: insufficient or improper use of chemical processes designed for pathogen destruction
S5: other process failures that permit pathogen survival§ No outbreaks in the data reported fall in this category.¶ An etiologic agent was not confirmed or suspected based on clinical, laboratory, or epidemiologic information.
For more information, please contact:Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636) / TTY: 1-888-232-6348
E-mail: [email protected]: http://www.cdc.gov
CS295288-A